1990, 10-24 Permit App: 90005638 Pellet StoveMECHANICAE' PERMIT APPLICATION FORM
J' ry
:information Worksheet
JOB STREET ADDRESS: )3."CCV /Ji(G(2/.t a
CITY/STATE/ZIP: 5CEMP (A)4 FOE? PARCEL NUMBER:
OWNER: /Aai ir& r , ' /a , /�
MAILING ADDRESS: J) .L /y??1 (J f/ j p,LL
CONTRACTOR:
(Street)
PHONE NUMBER:
MAILING ADDRESS:
LICENSE
PHONE
SP6 44. [4i gq.216
(City/State) (Zip)
NUMBER:
NUMBER:
(Street)
(City/State)
(Zip)
MECHANICAL
DESCRIPTION
WORKSHEET/FEE SCHEDULE
NUMBER X EACH
OF UNITS UNIT
DUCTWORK SYSTEM
WOODSTOVE/INSERT
GAS WATER HEATER
HEATING EQUIPMENT <100,000 BTU
HEATING EQUIPMENT +100,000 BTU
GAS PIPING (EA OUTLET)
REFRIG 1-100M BTU (NOT A/C OR HEAT PUMP)
REFRIG 101-500M BTU
REFRIG 501-1,000M BTU
REFRIG 1,001-1,750M BTU
REFRIG +1,750M BTU
AIR CONDITIONER 0-3 TONS _ _
AIR CONDITIONER 3-15 TONS
AIR CONDITIONER 15-30 TONS
AIR CONDITIONER 30-50 TONS
AIR CONDITIONER +50 TONS
FANS
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
VENTILATING
EVAPORATIVE COOLERS
TYPE I HOOD (PER 12
TYPE II HOOD
OR 12' PTN. OF HOOD)
CLOTHES DRYER
RANGE
GAS LOG
MISCELLANEOUS (NOT COVERED ELSEWHERE)
UNLISTED GAS APPLIANCE <400,000 BTU
UNLISTED GAS APPLIANCE >400,000 BTU
USED APPLIANCE <400,000 BTU
USED APPLIANCE >400,000 BTU
AIR HANDLER <10,000 CFM
AIR HANDLER >10,000 CFM
= AMOUNT
x$10.00
x 25.00
x 10.00
x 12.00
x 15.00
x 1.00
x 12.00
x 20.00
x 25.00
x 35.00
x 60.00
x 12.00
x 20.00
x 25.00
x 35.00
x 60.00
x 10.00
x 10.00
x 50.00
x 10.00
x 10.00
x 10.00
x 10.00
x 10.00
x 50.00
x100.00
x 50.00
x100.00
x 12.00
x 15.00
NOTE'
SIGNATURE
M P'T/ FEE IS 35.00
/ tJ
SUBTOTAL
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $
Spokane Coun ? Department of Building and Safety
West 1303 Broadway venue Spokane, WA 99260 (509) 456-3675
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